Four Steps to Take Telehealth to the Next Level

Sept. 4, 2020
We have identified a few key areas that will need more attention and resources in order for telehealth to reach its full potential

Just six months ago,  our physician group was not using telehealth. But in response to the COVID-19 outbreak—and facing an imminent shut down of elective activity—we put telemedicine on the fast track, developing an enterprise-wide program in less than one week. It took off like wildfire, and now more than 500 physicians use telehealth routinely, logging in to take part in about 1,300 patient visits each day.

Looking back, I’m amazed at how much we have learned in such a short amount of time. Perhaps most notably, it’s quite clear that our patients were ready, willing and able to embrace telehealth services. Across all age groups, including older patients, people have told us how much they appreciate the convenience of online visits. Telemedicine eliminates the hassles associated with in-person appointments, all of which are exacerbated with worry about increased exposure to COVID-19.

Our physicians like telehealth, too. It allows us to build more flexibility into our schedules and reduces foot traffic in our offices. In addition, online visits offer us new insights into our patients’ living environments; when we are able to see them in a more holistic way, we are able to care for them in a more holistic way.

Physicians in our practice support the full integration of telemedicine and believe it should be a permanent part of our practice. But to take telehealth to the next level, we have identified a few key areas that will need more attention and resources in order for telehealth to reach its full potential. Here in Massachusetts and across the country, providers need to:

  1. Improve language support: Interpreters and other forms of language support are just as important for online visits as they are for in-person ones. However, aligning interpreters with the patients who need them can add significant operational, as well as technical, challenges. In fact, in our practice, meeting our patients’ needs for language support has emerged as one of our primary telehealth challenges. In a recent survey of our providers using telehealth, 80% identified including interpreter services into video visits as a crucial feature for improvement.
  2. Demonstrate sensitivity to privacy concerns: HIPAA regulations control for confidentiality on the physician’s end of the telehealth environment. But there is no way for us to safeguard privacy on the patient-side of the connection. That generates a wide range of new confidentiality challenges, from difficulties in screening for intimate partner violence to concerns about “Zoom bombing,” visits being recorded, and appointments being tracked. Moreover, when a patient doesn’t feel they are in a safe, private space, they may be less forthcoming in discussing their medical issues.  Even speaking in front of a loving spouse or children about the details of medical conditions can be an anxious and uncomfortable situation for some patients.
  3. Acknowledge and address increased risk of physician burnout: Telehealth can create the misperception—for both patients and clinicians—that doctors are always on call.  Add in the physical manifestations of increased screen time, such as eye fatigue and the musculoskeletal impacts of a more sedentary workday, and it’s no surprise that some physicians are reporting increased job stress. We also need to recognize that telemedicine diminishes some aspects of the way we practice which can make us feel less confident.  For example, when we are not in the same physical space as our patients, we miss out on physical cues such as how well someone is walking and moving. In addition, communication changes because we can’t rely on traditional cues for comfort/discomfort, when to change topics, when to end the visit.
  4. Continue easing barriers to reimbursement: While regulatory frameworks and provisions for reimbursement have shifted recently, we have started to hear about efforts to reduce or discontinue reimbursement for some key  forms of telehealth visits.  Patients need to join providers in leading efforts to prevent a dialing back of access to this service.  Much more needs to be done to ensure that providers can test new platforms and continue to reap the benefits of telemedicine post-pandemic.  

Telehealth has proven a great step forward for our patients, and we are eager to continue to improve our approach. The key to continued acceptance of telehealth by patients, providers and payers is to determine exactly how telehealth best enables high quality care. In our practice, the biggest benefit is that it allows us to right size our interactions with patients in a very customized way. On one side of the spectrum are patients who need a brief communication by text; on the other, there are patients who have conditions that absolutely necessitate an in-person visit. Telemedicine offers a tremendously valuable bridge between these two extremes, with many stops in between. It gives us new options for optimizing and individualizing care and ultimately, will lead to cost savings and improved health overall.

Dr. Alexa B. Kimball is the President of Physician Performance LLC (PPLLC), CEO of Harvard Medical Faculty Physicians (HMFP) at Beth Israel Deaconess Medical Center (BIDMC) and a Professor of Dermatology at Harvard Medical School.

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